Healthcare providers must address several levels within a "pyramid" model to maximize public health, the director of the Centers for Disease Control and Prevention (CDC) writes in a column for the New England Journal of Medicine.
Truly effective public health addresses five tiers, according to CDC Director Tom Frieden, M.D.:
- The base, which consists of socioeconomic determinants, including income, employment status, race and education.
- Public healthcare interventions such as expanded health coverage or contraception access are the next level.
- Long-term preventive interventions, such as immunizations, are the middle level.
- Clinical interventions such as blood pressure management, are next.
- Education and outreach efforts, such as teaching people the value of healthy eating, are at the top level.
Although every level is important, Frieden writes, the lower the pyramid goes, the more people's health the corresponding intervention affects.
For meaningful population health improvement, healthcare must improve on the third and fourth levels--preventive and clinical interventions, according to Frieden. For example, blood pressure monitoring stands to prevent more deaths than any other intervention but is only effective in about half the population. This is a particular concern because almost 9 in 10 uncontrolled hypertension patients are insured, while more than 8 in 10 touch base with their care providers multiple times per year.
Clinical systems that effectively address public health have five key components, according to Frieden:
- Team-based care
- Patient-centered care
- Continual improvement in delivery and treatment
- Registry-based information systems
To learn more:
- read the column